Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD00016863 | WA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD00016863 | WA |
NPI | 1265478929 |
---|---|
Provider Name | Gary A. Koch |
First Address | Seattle, WA 98112-5226 |
Second Address | Seattle, WA 98112-5226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A05809 | (02) | WA |